Regional Collaboratives Maintaining Independence Through Interdependence

Transcription

1 Regional Collaboratives Maintaining Independence Through Interdependence Martie Ross Principal Pershing Yoakley & Associates, P.C. John Dawes President and CEO Bothwell Regional Health Center Tom Tisone Executive Director Health Network of Missouri Glen Nelson Board Chair Bothwell Regional Health Center Page 1

2 Rural Communities Residents are older, sicker, poorer, more likely to be uninsured, have higher healthcare costs Fiercely independent Survival depends on access to healthcare Page 2

3 Pressure to Consolidate Page 3

4 Capital Investment Options For Consolidation Asset Purchase/Acquisition Lease Joint Operating Agreement Merger/ Membership Substitution Joint Venture Minority Investment Management Agreement Loss of Control Page 4

5 Another Option: Regional Collaboratives MSO Management Services Organization CIN Clinically Integrated Network Page 5

6 Management Services Organization Independent providers form new company Governance structure to support decisionmaking process Leverage resources and pursue economies of scale Learning collaborative Group purchasing arrangements Combine administrative functions Coordinated IT solutions Page 6

7 Clinical Integration Providers accountable to each other and to community to deliver value high-quality care in efficient manner Collectively define and enforce standards of care Coordinate patient care Page 7

8 Clinically Integrated Network Lean infrastructure to support provider accountability Governance Management Participation Core Functions Evidence-Based Decision-Making Quality Improvement Care Coordination and Care Management Page 8

9 Interdependence Regional Collaboratives Two+ hospitals enter into formal relationship to share resources with eye toward clinical integration Participants together define common interests to be advanced through Collaborative Participants make financial commitment to support Collaborative s operations Page 9

10 Independence Regional Collaboratives Participants retain management authority of their respective organizations Participants retain financial independence of their respective organizations Participants governance remains with their respective governing boards Page 10

11 Motivations Achieve economies of scale through joint purchasing and similar strategies Leverage current and future information technology investments Sustain members as they learn to thrive under new care models Design continuums of care for specific types of patients Improve quality of care through common evidence-based clinical guidelines Develop narrow networks for contracting purposes Defend against competition from larger integrated delivery systems Test the waters for more involved relationships Page 11

12 Getting Started: A Win/Win/Win Strategy Page 12

13 Four Stages of Collaborative Development Stage 1: Identify coalition of the willing Stage 2: Develop internal strategy Stage 3: Jointly establish terms of relationship Stage 4: Commence and maintain collaborative Page 13

14 Stage 1: Identify Coalition of the Willing Start the conversation Develop selection criteria Identify and engage interested parties Page 14

15 Stage 2: Develop Internal Strategy Engage in level-setting education Define rationale and objectives for pursuing a collaborative Determine preferred scope (what you want in, what you want out) Examine feasibility Make go/no-go decision Letter of intent Page 15

16 Stage 3: Jointly Establish Terms of Relationship Define business aims and outcomes Identify and prioritize objectives Determine scope (what s in, what s out) Custom design and memorialize governance structure Develop preliminary business plan Commit financial and human resources Enter into letters of intent Page 16

17 Stage 4: Commence and Maintain Collaborative Operationalize governance structure Engage in strategic and operational planning Refine business plan Secure information technology infrastructure Develop timelines and link resources Page 17

18 Form Follows Function Define Business Aims and Outcomes (Function) Identify and Prioritize Objectives (Function) Determine Scope (Function) Custom Design and Memorialize Structure (Form) Page 18

19 Health Network of Missouri Page 19

20 Health Network of Missouri Academic medical center + 4 community hospitals 2+ years as learning collaborative Formed new entity in June 2014 to develop clinically integrated network Page 20

21 Health Network of Missouri Page 21

22 Network Compacts Covenants among all Members Developed and operationalized by task forces comprised of Member representatives Specific charges to task forces developed through Steering Committee planning process Interactive and mutually supportive Page 22

23 Member Contracts Vehicle for arrangements between less than all Members Allows Alliance to move expeditiously on matters of interest to individual Member groupings Network Compact development takes priority, but can pursue Member Contracts at same time Transparency between Members about work being done under Member Contracts Page 23

24 Challenges to Overcome and What Works Challenges Overcome Learning Collaborative Focus Fostered Dialogue Created Frustration 800-Pound Gorilla Desired Resources Feared Power Bureaucratic Building Trust Equality Investment Process Demonstrate Success Quick Wins Investment in Process Sustainability Lessons Learned Need for Shared Strategy Need for Discipline Independent Survey Self-Awareness Give Trust to Get Trust Shared Governance Equal Financial Investment Leveraged Resources Commitment to Process Disciplined Process Commitment of Resources Shared Leadership Compacts/Contracts Demonstrated Progress Small Successes Continued Commitment Page 24

25 Academic Medical Center Perspective Historical perspective Operational and organizational execution Structure Compacts to Contracts Page 25

26 Realities Facing the Board Physician Alignment Losing Market Share in Key Service Lines Difficulty Replacing Aging Physicians Technology and Data Collection Transitioning to Value-Based Payment Models Improving Quality While Reducing Cost Strong Desire to Remain Independent Page 26

27 Third-Party Integrated Strategic and Financial Planning Merger/Sale Stand-Alone/ Build Your Own Hybrid Stand-Alone Full merger with non-profit Physician Network Exclusive relationship with single organization Sale to for-profit Community Hospital Coalition Relationship with multiple providers across specialties and services Page 27

28 None of the Above Bothwell Regional Health Center and Clinics Develop effective hospital/physician Relationships Strategy to re-capture outmigration Cost management/margin improvement Recruit Recruit Recruit Health Network of Missouri Page 28

29 Rural Hospital CEO Perspective Benefits of membership in the HNM to date: Use of the MU hospitalist program since July 1, 2014 substantial annual savings Participation in Provider Recruitment fairs for Members only Use of the Simulation van for clinical training twice a year Health Information Exchange partner to better coordinate care Formation of the Healthy Community Partnership toward population health management Quality improvement initiatives in preparation for transparency and future network contracting opportunities Page 29

30 Your Perspective Consolidation vs. Collaboration Community response? Too much, too little? Mutually exclusive? MSO vs. CIN Timing Page 30

31 Questions? Page 31